11C‐Metomidate PET/CT is a useful adjunct for lateralisation of primary aldosteronism in routine clinical practice

Abstract

Objective

To describe clinical practice experience of ¹¹C‐Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone producing adenomas (APA) in primary aldosteronism (PA).

Context

Accurate lateralisation of aldosterone producing adenomas in the setting of primary aldosteronism (PA) offers the potential for surgical cure and improved long‐term cardiovascular outcomes. Challenges associated with adrenal vein sampling, the current gold‐standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralisation, including the application of novel molecular PET tracers such as ¹¹C‐Metomidate.

Design

Clinical Service Evaluation / Retrospective audit.

Patients

Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with ¹¹C Metomidate PET/CT prior to final clinical decision on surgical versus medical management.

Measurements

All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. ¹¹C‐Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy.

Results

We describe the individual lateralisation and clinical outcomes for 15 patients with PA.

Conclusion

¹¹C‐Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision making for PA within a multidisciplinary hypertension clinic.

This article is protected by copyright. All rights reserved.

http://bit.ly/2TwQcOv